Transcript Slide 1
Unsafe Abortion Mortality: New
Estimates and Trends, Health and Social
Consequences
Professor FE Okonofua
University of Benin, Nigeria
Presented at the International
Interdisciplinary Symposium on Reducing
Maternal Mortality in sub-Saharan Africa:
better understanding for better action
Dakar, Senegal – December 13-16, 2010
July 18, 2015
1
Background
The WHO defines Unsafe Abortion as: “A procedure for
terminating an unintended pregnancy that is carried out
either by a person lacking the necessary skills or in an
environment that does not conform to minimal medical
standards, or both¨
Despite increasing prevalence of contraception and the
existence of safe and effective methods of abortion,
millions of unsafe abortion continue to take place globally
each year resulting in increased risks of associated
morbidity and mortality
The objective of this presentation is to provide the most
recent WHO estimates of unsafe abortion and to elucidate
the associated health and social consequences
July 18, 2015
2
Methodology
Review of the most recent WHO publications and
database on unsafe abortion and associated
mortality
Review of other publications relating to trends in
abortion incidence and mortality
Recent papers published by Shah and Ahman in
Reproductive Health Matters and Susheela Singh
in the Lancet
July 18, 2015
3
Unsafe Abortion in 2008
WHO estimates that 21.6 million unsafe abortions took
place worldwide in 2008, almost all in developing
countries
The best indicators for measuring unsafe abortion are:
- Unsafe abortion rate: the number of
unsafe abortions per 1000 women aged 15-44 years
- Unsafe abortion Ratio: the number of unsafe
abortions per 100 live births
July 18, 2015
4
Estimated Annual Incidence of Unsafe Abortion
per 1000 Women Aged 15-44 years, by UN Subregion, 2008
Unsafe Abortion
Ratio (per 100
live births)
(rounded)
Unsafe
Abortion Rate
(per 1000
women aged
15-44 years)
21,600,000
360,000
21,200,000
5,020,000
5,510,000
6,190,000
2,430,000
930,000
900,000
120,000
14
1
16
27
31
28
36
36
18
9
16
3
17
18
17
17
20
18
18
10
Number of
Unsafe
Abortions
World
More developed regions*
Less developed regions
Least developed countries
Sub-Saharan Africa
Africa
Eastern Africa
Middle Africa
Northern Africa
Southern Africa
5
Contd
Western Africa
1,810,000
28
16
Asia*
10,810,000
12
14
Eastern Asia*
°
°
°
South-Central Asia
6,850,000
17
17
South-eastern Asia
3,130,000
22
28
Western Asia
830,000
16
16
Europe
360,000
2
5
Eastern Europe
360,000
5
12
Northern Europe
°
°
°
Southern Europe
°
°
°
Western Europe
°
°
°
Latin America and the Caribbean
4,230,000
31
39
Caribbean
170,000
18
22
Central America
1,070,000
29
34
South America
2,990,000
32
43
Northern America
°
°
°
Oceania*
18,000
8
7
Australia/New Zealand
°
°
°
July 18, 2015
6
Estimated Annual Number of Unsafe Abortions,
Rates and Ratios, By Geographical Regions, 2008
July 18, 2015
7
Unsafe Abortion Rates Per 1000 Women of
Ages 15-44 For All Countries
July 18, 2015
8
Estimated Number of Unsafe Abortion Globally and by Major
Regions, 2003 and 2008
July 18, 2015
9
Unsafe Abortion Rates Per 1,000 women
July 18, 2015
10
Consequences of Unsafe Abortion
Despite being a simple procedure, one in four women
having an unsafe abortion face the risk of severe
complications
Worldwide, unsafe abortion account for 13% of maternal
deaths, and 20% of overall burden of maternal death and
longer term disability as measured in Disability Adjusted
Life-Years (DALYs)
Compared with developed countries the burden per 1000
unsafe abortions is more than six times as high in subSaharan Africa and four times as high in Asia
July 18, 2015
11
Consequences of Unsafe Abortion
Unsafe abortions accounted for 20,500 maternal
deaths in 2005
Among the estimated 358,000 global maternal
deaths in 2008, 47,000 were due to complications
of unsafe abortion (nearly a doubling)
Over half of these were in Africa, while 34%
occurred in the least developed countries
MMR associated with abortion was 650 deaths
per 100,000 unsafe in 2003 , compared to 10 per
100,000 in developed countries
July 18, 2015
12
36% The World’s Population Live Where
Abortion is Very Restricted
26%
Prohibited altogether
or only to save life
40%
Physical Health
Mental Health
Socioeconomic
10%
Without restriction
3%
21%
July 18, 2015
13
Restricting Contraception and Legal Abortion In
Romania Resulted In Increased Maternal And Abortionrelated Deaths
Maternal and unsafe abortion deaths per 100,000 live births, by year, Romania
200
Maternal deaths
Abortion deaths
160
120
80
40
0
1960
1964
July
18, 20151968
1972
1976
1980
1984
1988
1992
1996
14
Distribution of Countries by Number of Deaths due to
Unsafe Abortion
Number
of
deaths
per
100 000
live
births
July 18, 2015
15
Distribution of Countries By Number of
Deaths Due to Unsafe Abortion
Region and Sub-region
Number of maternal
deaths due to unsafe
abortion (rounded)
Deaths due to unsafe
abortion (as % of all
maternal deaths)
Deaths due to unsafe
abortion per 100,000
live births (rounded)
World
More developed
Less developed
Countries
Least developed
countries
Less developed regions,
excluding China
Africa
Eastern
Middle
Northern
Southern
Western
70 500
<60
70 400
13
4
13
55
.
60
24 000
10
85
70 400
13
70
38 400
14 800
6600
1200
500
15 300
14
17
11
11
9
13
115
130
130
25
40
140
July 18, 2015
16
Estimates of Deaths due to Unsafe
Abortion in 2005 in three countries
Annual number of women treated
in hospital for induced abortion
complications
Annual hospitalization rate
for induced abortion
complications per 1000
women
Egypt
216 000
15.3
Nigeria
142 200
6.1
Uganda
85 000
16.4
July 18, 2015
17
Health Consequences Are Often Severe
And Can Be Long-term
Kenya: 28% of post-abortion patients
experienced severe complications
Nigeria: among hospitalized patients, one in 3
had hemorrhage, one in four sepsis and about
1 in 10 had injury to other organs
Abortion in the second trimester greatly
increases risk
There are many long-term consequences
July 18, 2015
Additional Consequences
Loss of productivity
Increased economic burden and cost to the public
health system
Social & cultural stigma
Long term ill-health, including infertility
Overall , some 24 million women are estimated to be
currently suffering from secondary infertility due to
unsafe abortion
July 18, 2015
19
Contraception is Key to Prevention Of Unsafe
Abortion
It is well documented that family planning
programs reduce abortion
There can be a lag: the desire for small families
may increase faster than contraceptive use
But contraception does not eliminate the need
for safe abortion, and there are several other
reasons why women result to abortion
Governments and stakeholders must improve
access to contraceptive information and services
July 18, 2015
Prevention of Unsafe Abortion Includes
More than Contraception
Access to safe and legal abortion is the most
fundamental means of prevention
Also important are use of safer techniques
and training of providers in these techniques
Manual vacuum aspiration is effective and
suitable for low resource settings
Early medication abortion is a new and
recommended technique
July 18, 2015
Prompt And Appropriate Treatment Of
Complications Is Also Important
WHO has issued guidelines for provision
of safe abortion care & treatment of
complications
Post abortion contraceptive counseling
and services are essential
Rapid transfer to tertiary care can be
lifesaving
July 18, 2015
The Public Health Imperative
The rationale for making safe abortion
available is well established
The public health record is clear and
incontrovertible: access to safe, legal
abortion improves health
Cairo, 1994:”In circumstances where abortion
is not against the law, such abortion should
be safe.”
July 18, 2015
Dealing with Unsafe Abortion in Africa
The Maputo Plan of Action
Enact policies and laws to reduce the incidence of unsafe
abortion
Prepare and implement national POA to reduce the incidence of
unwanted pregnancies & unsafe abortion
Provide safe abortion services to the fullest extent of the law
Educate communities on available safe abortion services as
allowed by natural laws
Train health providers in prevention and management of unsafe
abortion
July 18, 2015
24
Mahmoud Fathalla Sums Up The Situation
Very Well
“Pregnancy-related deaths are often the
ultimate tragic outcome of the cumulative
denial of women’s human rights. Women
are not dying because of untreatable
diseases.
They are dying because
societies have yet to make the decision
that their lives are worth saving.”
Simply put, they die because they do not
count.
July 18, 2015
Some References:
Shah H, Ahman E. Unsafe abortion: global and regional
incidence, trends, consequences and challenges. J Obstet
Gynecol Can 2008; 31: 1149-1158.
Singh S. Hospital Admissions resulting from unsafe abortion:
estimates from 13 developing countries. Lancet 2006; 368:
1887-1892.
Grimes D, Benson J, Singh S, Romero M, Ganatra B, Okonofua
FE, Shah IH. Unsafe abortion: A preventable pandemic. Lancet
2006 (Special Edition): 65-76.
Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH. Induced
abortion: estimated rates and trends worldwide. Lancet 2007,
370, 1338-1345
July 18, 2015
26
Acknowledgements
Dr Alain Prual of UNFPA,
and
Dr Brooke Levandowski of Ipas, USA
For sharing some of the reading
materials with me.
July 18, 2015
27
Thank you
Merci
July 18, 2015
28